Australian Aboriginal and Torres Strait Islander people experience a higher level of health inequality than non-Indigenous Australian people (Australian Human Rights Commission, 2018). This issue of health inequality is being addressed through the implementation of Aboriginal Controlled Health Services and primary health care services, along with initiatives such as the Close the Gap campaign for Indigenous health equality. This piece will aim to outline what Aboriginal Controlled Health Services, the Close the Gap Campaign and primary health care are, with the purpose of identifying how both health care strategies employ aspects of primary health care to ensure their operation and success. It is clear that health inequality between the two population subgroups is a dominant issue facing Australia’s health society, and so must be addressed to ensure equality in health outcomes for both Indigenous and non-Indigenous peoples (The Australian Government Department of the Prime Minister and Cabinet, 2018).
Aboriginal Community Controlled Health Services (ACCHS) are Primary Health Services that are culturally appropriate and initiated, planned and governed by local Indigenous communities (Bell et al., 2000). ACCHS must be located and initiated by a local Aboriginal community, be governed by an Aboriginal board of directors that is elected by members of the local aboriginal community and must deliver holistic and culturally appropriate care to the community (Bell et al. (2000). ACCHS are important as they significantly improve access to health care by being flexible and responsive in the delivery of care, resulting in more Indigenous people being able to access the care they need (Bell et al., 2000). Furthermore, a full range of services is able to be provided that are both cost effective and cost efficient, with services delivered being based on local knowledge and targeted at areas of local need (Bell et al., 2000).). Moreover, ACCHS provide culturally sensitive and inclusive care, that is able to cater for both the cultural and social needs of Indigenous people (Bell et al., 2000). ACCHS range from large, multifunctional facilities to small services, both of which can include services such as immunisations, antenatal care, emergency care, management of chronic illness and pharmaceutical supply systems (National Aboriginal Community Controlled Health Organisation, 2018).For example, the Waminda South Coast Women’s Health and Welfare Aboriginal Corporation provides a culturally safe and ACCHS for women and their Indigenous families that free to women and children and aims to provide tailored strength based care (Waminda, 2018).
The Close the Gap campaign for indigenous health equality is an Australian Government initiative that seeks to close the gap in health and life expectancy between Aboriginal and Torres Strait Islander people and non-indigenous Australians before the year of 2030 (Australian Human Rights Commission, 2018). The campaign identifies Indigenous peoples to be an at risk group for adverse health outcomes and so has been implemented as an evidenced based, risk management intervention for health promotion (Australian Human Rights Commission, 2018). The Australian Government Department of the Prime Minister and Cabinet (2018) suggests that the Close the Gap campaign is both important and necessary as it aims to address the disadvantage of Indigenous people and achieve health equality in order to improve the lives of Aboriginal and Torres Strait Islander peoples.
The Australian Institute of Health and Welfare (AIHW, 2016) highlights the inequality in life expectancy between the two population subgroups. In 2012, life expectancy for non-Indigenous males was estimated to be 79.7 years compared to 69.1 years for Indigenous males (AIHW, 2016). For non-Indigenous females in 2012, life expectancy was estimated at 83.1 years compared to 73.7 years for Indigenous females (AIHW, 2016). The Australian Government Australian Institute of Health and Welfare (AIHW, 2010) additionally shows that Indigenous Australians experience a higher level of burden of disease than non-Indigenous people. The rate of fatal burden of disease experienced by Indigenous Australians in 2010 was found to be 2.6 times that experienced by non-Indigenous Australians (AIHW, 2010). The Australian Institute of Health and Welfare (2010) found that Indigenous Australians experience higher rates of diseases including cardiovascular, endocrine and cancer. For example, in 2010 cardiovascular disease in Indigenous Australians made up 62 years of life lost per 1,000 years compared to 21.2 for non-Indigenous Australians (AIHW, 2010).
The inequalities in health and life expectancy between Indigenous and non-Indigenous people can be largely attributed to inequalities in social determinants between the two population subgroups (Marmot, 2011). The World Health Organisation (2018) defines social determinants of health as the circumstances in which people are born live, work and age.
For this reason, to achieve the goal of closing the gap in life expectancy and health outcomes between Indigenous and non-indigenous people, the close the gap campaign outlines six targets to be reached that focus on areas related to social determinants of health. These include closing the life expectancy gap within a generation, halving the gap in mortality rates for indigenous children under five, ensuring access to early childhood education for all indigenous four year olds in remote communities, halving the gap in reading, writing and numeracy achievements of children, halving the gap in indigenous students year 12 attainment rates and halving the gap in employment outcomes between indigenous and non-Indigenous Australians (Dr John Gardiner-Garden, Australian Parliament).
Guzys, Brown, Halcomn and Whitehead (2017) define primary health care as a philosophical approach to health care in which health is recognised as a fundamental human right, in addition to being both an individual and collective responsibility. Kralik and van Loon (2011) moreover describe Primary health care as the first point of contact, essential care that is affordable, accessible, acceptable and available to clients.
Primary health care is linked to the social determinants of health as the primary health care approach is based on the social model of health (Guzys et al., 2017). The social model of health employs a broad view of the interactions that occur within a society that influence both individual and community health (Guzys et al., 2017). These factors include biology, family and social groups, community factors, environmental and financial factors that can positively or negatively influence the achievement and maintenance of good health and wellbeing (Guzys et al., 2017).). Furthermore, Primary health care places responsibility on the role that housing, education and employment has to play in an individual’s health (Guzys et al., 2017). World Health Organisation (2003) thus outlines that the key principles of primary health care are based on social determinants of health and include universal access to care and coverage on the basis of need, commitment to health equality to achieve social justice, community participation in outlining and implementing health agendas and an approach to health that considers sectors outside that of health.
Elements and process of primary health care can be seen in ACCHS as well as in the Close the Gap campaign for Indigenous health equality (Guzys et al., 2017). Couzos and Murray (2008) state that ACCHS provide the best example of the implementation of primary health care in Australia. Primary health care is considered to be relevant to ACCHS due to its focus on social justice, community participation and intersectoral collaboration (Guzys et al., 2017). The principle of community participation by which primary health care is operated is implemented across ACCHS and sees the full participation, self-reliance and self-determination of Aboriginal people in the delivery of such services (Couzos & Murray, 2008). In this way, services are able to be considered and tailored to both promote and prevent relevant health issues that the indigenous community faces (Guzys et al., 2017). Furthermore, increased community involvement leads to increased investment and interest in positive health outcomes for the community, highlighting the importance of primary health care in ACCHS (Guzys et al., 2017). Community controlled health services are further identified as primary health care as they aim to increase the availability, accessibility and affordability of culturally appropriate and relevant care (Bell et al., 2000). ACCHS care based on the principles of primary care, by recognising that optimising Indigenous health outcomes is a basic human right and working collaboratively provide care that is culturally appropriate, affordable and more available to their clients (Bell et al., 2000).
Additionally, primary health care is important for the close the gap campaign for Indigenous health equality as the primary model of health care has been identified as being appropriate in addressing disparities in health between Indigenous and non-Indigenous people due to the emphasis on preventative and health promoting practice (Guzys et al., 2017).). The close the gap campaign is a form of primary health care as it acknowledges that responsibility to combat health inequality is placed both on the individual as well as collective groups and seeks to improve health outcomes by targeting areas that are influenced by the social determinants of health (Kralik & van Loon, 2011; World Health Organisation, 2018). Marmot, Friel, Houweling and Taylor (2008) further recognise that the Close the Gap campaign implements the notion that best health outcomes measurable by life expectancy and mortality are achieved when based on primary health care. And so, the campaign implements primary health care by emphasising local, culturally appropriate action that aims to prevent and promote health in balance with investing in curative interventions.
In conclusion, strategies have been implemented to address the concerns regarding health inequalities seen between Indigenous and non-Indigenous peoples. These strategies include Aboriginal Community Controlled Health Services, which are local, community run health services that aim to increase availability, affordability and appropriateness of care. Furthermore, the Close the Gap campaign for Indigenous health inequality aims to address the gap in Indigenous health outcomes and life expectancy by reaching set targets that address social determinants that influence health outcomes. Both strategies implement aspects of primary health care, which is a philosophical approach to health care that sees health as being a basic human right. Furthermore, primary health care is the first point of contact and aims to be affordable, accessible, available and appropriate for clients. In summary, both Aboriginal Community Controlled Health Services and the Close the Cap campaign for Indigenous health equality are primary health care initiatives that aim to combat inequality in health experiences by the Aboriginal and Torres Strait Islander peoples.